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Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

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Structural validity of the Anxiety Symptom Scale - a Danish validation study.

Henrik Schou Pedersen¹, Karl Bang Christensen², Anders Prior^1,3

¹Research Unit for General Practice, Aarhus, Denmark.

Nordic Journal of Psychiatry

|February 20, 2025

Summary

The Anxiety Symptom Scale (ASS) effectively measures global anxiety and functional impairment in general practice. Reducing response categories did not improve its performance as a screening tool.

Keywords:

Anxiety general practice psychometrics validation

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Area of Science:

Psychiatry
Psychometrics
General Practice

Background:

The Anxiety Symptom Scale (ASS) is a 10-item psychometric tool used for anxiety screening in Danish general practice.
It comprises nine anxiety symptom items and one functional impairment item.
Prior research suggested potential benefits from reducing response categories and its unidimensionality.

Purpose of the Study:

To evaluate a modified ASS with fewer response categories.
To compare the psychometric structure of the original and modified ASS versions.
To assess the ASS's utility as a unidimensional measure of global anxiety and its correlation with functional impairment.

Main Methods:

A modified version of the ASS with reduced response categories was created.
The original and modified ASS versions were compared using a bifactor model.
Respondents were recruited from general practice consultations, mental health associations, and a general practice waiting room.

Main Results:

The original ASS version demonstrated a better fit to the bifactor model than the modified version.
The bifactor model indicated that the ASS primarily measures a single underlying trait (global anxiety).
The general factor strongly predicted functional impairment.

Conclusions:

The first nine items of the ASS serve as a unidimensional measure of global anxiety, correlating significantly with functional impairment.
The ASS is valuable for general practitioners in initial treatment decision-making.
Reducing response categories or removing a specific item did not enhance the instrument's performance.